KDHE to Launch Enhanced Prior Authorization System

Annual Savings Estimated at $1.5 M

Topeka— The Kansas Department of Health and Environment (KDHE) Enhanced Prior Authorization (PA) System for prescriptions will go live at 1 a.m. on Tuesday, Aug. 23. KDHE has worked with Affiliated Computer Services (ACS) since January to design the system.

“This is just the first step in our work with ACS to streamline PA processes for Medicaid providers, improve the coordination of care and establish additional savings,” said Andy Allison, PhD, Director of KDHE’s Division of Health Care Finance.

Enhancing the PA process allows the state to migrate from a mostly manual process to a more automated process with the objective of minimizing the overall time required to fill prescriptions and receive medical services, thus reducing administrative costs for payers and providers. This enhanced option will be implemented statewide and will affect the Medicaid population. “We expect savings from the implementation of Enhanced PA will meet or exceed the original estimate of $1.5 million per year,” said Barbara Langner, State Medicaid Director.

Kelley Melton, Senior Pharmacy Program Manager, said the state initially proposed automating the prescription drug prior authorization system in a FY 2008 budget enhancement. “We recognized it would save money and reduce the administrative burden experienced by providers,” said Melton. “We are very proud to have now reached the milestone of activating the electronic PA system.”

Kansas Medicaid currently operates a mostly manual PA system for pharmaceuticals, which requires a review of certain prescription drugs by a trained health provider before the drug is authorized. PA requests in the Kansas Medicaid program are generally submitted by mail or fax and simple requests are reviewed by nurses.

Launching the Enhanced PA will ensure medical services and prescription drugs provided to beneficiaries are medically necessary and cost effective. This new system queries patients’ medical and pharmacy claims history in real time to determine the appropriateness of therapies based on established best practices criteria. Pharmacists will receive real time notification, generally within seconds, of PA denials or requirements for additional information allowing them to select more appropriate therapy at the point of care.